Vol 44 # 2 June 2012 - Kma.org.kw

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115 Comparison of Changes in Body Image of Patients with Renal Calculi Treated ... June 2012 9 Resistance to compulsions (On what scale do you resist to difficulties resulted from body disorders?) A. Always making an effort to resist or symptoms are too little to require any effort B. Trying to resist for most of the time C. Making a little effort to resist D. Submitting to these difficulties without trying to control but making this without intention E. Totally submitting to difficulties related to body disorders willingly 0 1 2 3 4 10 11 12 Control level of compulsive behaviors (On what scale can you control yourself against forcing situations resulting from body disorders in your daily life?) A. Total control B. Control on a great scale, feeling pressure to realize activity but generally being able to control with your own will C. Moderate control, feeling a strong pressure to realize activity but being able to control with difficulty D. Slight control, feeling a great pressure to realize activity, having to complete but hardly being able to postpone E. No control, being forced to realize activity without your own will in an excessively strong manner and rarely realizing activity only for a moment Insight: (On what scale do you consider about this body disorders as logical when you question the condition? A. Perfect insight, totally logical B. Good insight, accepting absurdity and excessiveness of thoughts and behaviors but seeming not totally convinced about the fact that there is nothing to worry about this condition other than distress C. Moderate insight, accepting excessiveness and absurdity of your thoughts and behaviors but hesitating, possibility of having some unreal fears but without any stable belief D. Weak insight, claiming that thoughts or behaviors are logical or excessive E. No insight, definitely believing that thoughts and behaviors are logical and not being convinced with the contrary evidences Avoidance: (On what scale do you avoid doing your daily life activities because of your body disorders?) A. No avoidance B. Slight, only a little avoidance C. Moderate, slight avoidance, avoidance is clear D. Avoidance on a great scale, avoidance is clear E. Excessive, very prevalent avoidance, patient avoiding almost all the activities 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 (male / female: 23/7) had PYL. Patients who had an additional factor that may affect the body image, such as previous surgery or claudication, were excluded from the study. Patients who accepted and signed our study protocol and were communicable, were chosen for the study. Patients were divided into two groups as PNL and PYL. Patients’ perceptions of body image was assessed with the body dysmorphic disorder scale (BDDS, Table 1). Prior to this study, the BDDS was tested in patients who had had an ileal conduit or an ileal neobladder [5] . Patients were assessed for BDDS, consisting of 12 questions, before surgery, at one month and at the end of six months after the surgery. BDDS form was completed by the same doctor. The answers to each question were scored from 0 - 4 points on a subjective scale [5] (Table 1). Higher BDDS score showed the patient’s poor perception of body image. Results were analyzed with SPSS for Windows®. Means and standard deviations were determined. Mean scores between the two groups of patients were compared using the t-test. A p-value lower than 0.05 was considered as statistically significant. RESULTS Mean ages of the patients were 43.48 ± 9.37 years (minimum: 28 years - maximum: 62 years) in the PNL group and 44.96 ± 8.73 years (minimum: 29 years - maximum: 61 years ) in the PYL group. There were no statistically significant difference between two groups in terms of age (p > 0.2). In the PNL patients, average BDDS scores before, at first month and at sixth months after the surgery were 13.12 ± 4.40, 14.79 ± 4.09 and 13.48 ± 4.33, respectively. In the PYL group the average BDDS scores before, at the first month and at the sixth months after the surgery were 13.86 ± 4.47, 17.03 ± 2.84 and 14.23 ± 3.98 respectively (Fig. 1). There were no statistically significant difference between the two groups in terms of BDDS scores before and at six months after surgery ( p > 0.4 and p > 0.4, respectively). However BDDS scores were significantly higher and perception of body image was significantly worse in the PYL group (p = 0.01) (Table 2). Table 2: Number of patients, mean BDDS scores and p-values (t-test) for two types of operation. Mean BDDS score Pre-operative 1 st month > 6 months Operation type (N = 69) PNL n = 39 (57%) 13.12 ± 4.40 14.79 ± 4.09 13.48 ± 4.33 PYL n = 30 (43 %) 13.86 ± 4.47 17.03 ± 2.84 14.23 ± 3.98 PNL: percutaneous nephrolithotomy; PYL : pyelolithotomy p-value > 0.4 0.01 > 0.4
June 2012 KUWAIT MEDICAL JOURNAL 116 were > 0.8, > 0.05 and > 0.9, respectively). Moreover, there was no difference in older patients Vs younger patients who had undergone PNL when the BDDS mean points for pre-operative and post-operative more than six months were compared (p > 0.1 and p > 0.1). However, post-operative first month BDDS mean point of the younger patients were significantly higher and the body image perception was more negative than older patients withPNL (p = 0.006). Fig 1: Mean BDDS scores of PNL and PYL patients In patients who had PNL, BDDS mean points for pre-operative, post-operative at the first month and post-operative after six months were compared and found to be not statistically significant (p > 0.08 Vs p > 0.7) In patients who had PYL, BDDS mean points for pre-operative, post-operative after six months and were not statistically significant (p > 0.7 ). However, BDDS mean point was considerably higher and the body image perception was more negative between the groups at the post-operative first month (p = 0.002) (Table 3). Table 3: The comparison of preoperative and postoperative BDDS median scores and p-values in PNL and PYL groups Operation type PNL PYL Mean BDDS score, Pre-op. and 1 st month 13.12 ± 4.40 14.79 ± 4.09 13.86 ± 4.47 17.03 ± 2.84 p- value 0.087 0.002 BDDS: Body dismorphic disorder scale Mean BDDS score, Pre-op. and > 6 months 13.12 ± 4.40 13.48 ± 4.33 13.86 ± 4.47 14.23 ± 3.98 p- value 0.718 0.739 BDDS mean points at the pre-operative, postoperative first month and post-operative after six months were compared between the male and female patients in the PNL group and were not statistically significant (p values were as follows: > 0.1, > 0.07 and > 0.5, respectively). Additionally, there was no difference between male and female patients who had PNL when BDDS mean points for pre-operative and post-operative at six months were compared (p > 0.1 and p > 0.4, respectively). However, post-operative first month BDDS mean point for the male patients who had PYL was considerably higher and the body image perception was more negative than females (p = 0.005). The BDDS mean points for pre-operative, postoperative first month and post-operative more than six months were compared for the younger patients Vs the older patients who had undergone PYL. There was no significant difference (p-values DISCUSSION Urinary tract stone disease is the third most common pathological condition in the urinary system, coming after urinary infections and prostate disease. In recent years, there has been a great progress in the medical treatment of urinary stone disease [3] . However, the majority of these patients still have a high rate of indication for surgical treatment. The aim of treatment in urinary tract stone disease, at the acute stage, is to recover from the pain and discomfort for the patient. On the other hand, the ultimate aim should be the clearance of urinary tract from stones as far as possible and to prevent new stone formation or growth of existing stone [3] . Providing high quality of life should be a target in this group of patients. By many changes in the view or function of any body part, body image is changed and the patient can see himself as completely different. Body image can vary by some reasons such as hormonal changes, illness, disability, injury, surgery, radiotherapy and chemotherapy [4] . In this study, patients with additional pathology that could adversely affect the body image were excluded. We found no study comparing body images after PNL and PYL in the English literature. We found few studies that compared changes in quality of life and body image in different types of urinary diversion. Hart and his colleagues reported no difference in body image changes of the patients with different types of urinary diversion [6] . However, some studies reported some differences in body image for different techniques of urinary diversion [7-8] . In our study, the change in body image in the early post-operative period was significantly different between PNL and PYL groups and average BDDS score was higher in PYL group. However, mean BDDS scores were not significantly different between two groups by age and sex at sixth months after the operation. This result may be due to the adaptation of patients to changes in body image at the late period. In previous studies, it was normal to expect different results about the impact of surgical method on body image. This is because in countries and societies and even within the same society, there are many differences in socio-economic status, life outlook, customs and way of life. Therefore, we recommended
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Vol 44 # 2 June 2012 - Kma.org.kw

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